Mental health, administrative disorder

On January 12, 2003,
a young woman's life changed forever because she was raped within the
precincts of the National Institute of Mental Health and Neuro Sciences
(NIMHANS) in Bangalore.

The victim was a 17-year-old schizophrenic girl (an in-patient at that
time), and the perpetrator, an HIV positive young man who is an
out-patient undergoing treatment for alcohol abuse. The heinous incident
occurred in the afternoon when the girl was sitting in the hospital
grounds reading a magazine, while her mother, her "guardian", was in the
ward.
The girl, though severely bruised, was alert enough to inform her mother
about her trauma. Her mother got in touch with the hospital authorities
immediately, but they made no effort to register a police complaint
against the rapist.

Matters would have remained at status quo but for the intervention of the
office of the Commissioner for Disabilities of the Government of
Karnataka, who swung into action the next day as soon as it heard about
the rape. A case was registered suo moto under the Disabilities Act, on
the strength of which the criminal was apprehended.
NIMHANS registered the case almost a fortnight later after pressure was
put on the hospital authorities by the Commissioner's Office.
Investigations are now under way. That the rapist was an HIV positive man
increases the seriousness of the crime and its
ramifications for the responsibilities of mental health
institutions in protecting vulnerable girls in similar situations.

Even today, NIMHANS refuses to take the blame for the crime. Their
contention is that it is the responsibility of the guardian to look after
the ward while she is undergoing treatment as an in-patient. In this
particular case, the patient and her mother had travelled to Bangalore
from Kolkata (West Bengal) since the facilities there were inadequate for
the girl's treatment and because NIMHANS is rated as the premier
institution for mental health in the country.

That many patients from different parts of the country come for
psychiatric treatment to NIMHANS bears testimony to this fact. Many
outstation families confirmed that facilities in other cities are a great
deal worse. Many families were reluctant to talk because a mentally ill
patient needs lifelong treatment and the families are at the mercy of the
doctors who monitor the treatment. However, several confirmed that
incidents of rape and ill treatment of patients are not uncommon even in
private nursing homes.

"It is most unfortunate that legislation permits
inspection teams to monitor what is happening in private hospitals but not
in government-run institutions."

Pradeep Kumar, Assistant Commissioner for Disabilities, Government of
Karnataka, says the constitutional rights of a mentally ill person are the
same as that of a 'normal' person and a hospital is duty bound to respect
these. The Mental Health Act of 1987 has introduced several provisos to
protect these rights. "It is most unfortunate that legislation permits
inspection teams to monitor what is happening in private hospitals but not
in government-run institutions."

Kumar says this should change now and government institutions should also
be brought under the purview of the Central or state Government with
regard to inspections that should be permitted at frequent intervals.
Inspection teams could comprise family members, experts in the field and
voluntary sector workers who should be allowed to talk to inmates and
freely move around the hospital premises. "There is a need to beef up
security in the hospitals as it is humanly impossible for a guardian to
watch her/his ward 24 hours a day," adds Kumar.

The appointment of an Office of the Commissioner for Disabilities goes a
long way in helping to take up cudgels on behalf of the mentally ill or
otherwise disabled. However, there is a dire need for officials filling
these positions to be sensitised to the problems of the mentally
challenged.
In most states, an officer of the Indian Administrative Service holds this
post as an additional charge. The Disabilities Act has a provision that
recommends that a person trained or involved in the field hold this post.
But as of today, only the state of Jharkhand has implemented this
recommendation by appointing a visually impaired person from the voluntary
sector to this post. The Chief Commissioner for Disabilities in New Delhi
is a woman with many years of experience in the voluntary sector. It would
be in the fitness of things if other state governments demonstrate their
involvement and support to the disabled by appointing a trained person to
the post of Commissioner for Disabilities.

"Parents need to be counselled with regard to speaking the truth when it
comes to facing problems in mental institutions so that matters can be
investigated and set right," says Kumar. In the NIMHANS case, the mother
of the victim was very reluctant to reveal the facts because the doctors
had said this would affect the treatment of her daughter. Fortunately,
that has changed. The victim's mother is now determined to see the case
through.

Chapter VII of the Mental Health Act deals with the liability of the
psychiatric hospital or nursing home with regard to the care of mentally
ill persons who are staying within its premises. In the case of this rape
victim, NIMHANS subjected her to a series of tests both within and outside
the hospital that the family was made to pay for. The Commissioner's
office intends to use the provisions of this act to make the hospital
compensate the family.

While the Mental Health Act may come in useful to take action against
errant hospitals, it is equally important for the people in general to
move away from the stigma associated with mental illness and be more
sensitive to the needs of the mentally ill. In most Indian families mental
illness within the family is kept under wraps for fear of jeopardising the
matrimonial prospects of marriageable young men and women.
At a recent seminar organised by the Disability Commissioner's Office and
Rotary in Bangalore, a courageous mentally ill young man said, "Every day
I get up and need to motivate myself to go to work. Most days I succeed,
some days I don't, but I don't give up." His employer spoke after him and
vouched for his efforts. According to the Superintendent of a halfway
home in Bangalore, "The attitude to mental illness can only change if we
accept the illness and the treatment for it just as we would for diabetes
or blood pressure."

With work pressures, nuclear families and the hectic pace of life, mental
illness may well end up being the number one malaise of the 21st century.
As always, women and girls are the most vulnerable among the mentally ill.
The trauma of this young woman clearly indicates that it is time
for NIMHANS to set its house in order.

Melanie P Kumar14 March 2003

Melanie P Kumar is a Bangalore based freelance
journalist; she writes on development issues

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